cervical dystonia, spasmodic torticollis spasmodic torticollis
Conditions
Interventions
Fly with the Owl, an in-house virtual reality game to stretch, extend and contract muscles of the neck by following instructions given by visual feedback.
Sponsors
Universitair Medisch Centrum Groningen
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: To be eligible to participate in this study, a subject must meet all the following criteria:Cervical dystonia outpatient from the UMCG.Age between 18 and 75 years old and disease duration longer than one (1) year.Stable treatment based on botulinum toxin for at least a year. The treatment is considered stable if the change in the total dosage of botulinum toxin did not exceed 25%.No other movement disorders or comorbidities interfering with cervical movements and cervical range of motion.
Exclusion criteria
Exclusion criteria: A potential participant who meets any of the following criteria will be excluded from participation in this study:Pregnancy based on self-report.Reported motion sickness in connection with a VR or computer game.People with a known history of epilepsy.People with known allergies to silver or plasters.People implanted with electronic devices of any kind, including cardiac pacemakers or similar assistive devices, electronic infusion pumps, and implanted stimulators.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The error between the trajectory of the head movement recorded by inertial measurement units and the desired trajectory. To evaluate this error the IMU records will be split into individual movements. This will be done by evaluating the turning points in the trajectory. If there are less turning points than expected movements the markers that the game adds to the data whenever a new movement is initiated in the scenario will be used for determining the start and end of a single stretching movement. After this we will a spatiotemporal analysis with dynamic time warping (DTW) according to Giese et Poggio [50]. This methods is commonly applied in the analysis of complex motion [51]. In addition, we will normalize the motion in time to be able to calculate commonly used error metrics such as the root mean square error RSME, which indicate how closely the participants were able to follow the trajectory in centimetres. This process is commonly carried out in other motion trajectory evaluations such as gait analysis [52]. This will allow us to compare with existing literature on exergames and discuss with physiotherapists about the in- game performance. | — |
Secondary
| Measure | Time frame |
|---|---|
| • Electromyography signals (EMG) of 8 muscles in the upper body that are usually involved in the exercise will be recorded to verify that the participants actually used the target muscles and did not succeed in the game by using compensatory movements. The activation of the muscles measured via the EMG should be consistent with the way the muscles are recruited to perform different movements of the head. Co-contraction of antagonistic muscles, imbalance of the contraction of agonistic muscles, or recruitment of muscle groups that are usually not needed to achieve a certain motion could potentially indicate that participants have difficulties playing the game. Due to the low sample size we can only perform an exploratory analysis on the data. However, this exploratory analysis could help us to identify patient group specific measures which could be used to improve the in-game feedback in future versions. As a guidance to the EMG parameters that might be different from the data we already obtained in a previous experiment, we will follow the steps suggested by Nijmeijer et al. [53]. • The Torticollis Severity and the Disability scales from the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [11] will be used before the gameplay to establish the severity of dystonia on the day of the experiment. The Disability Scale assesses the effect of the patient's dystonia on doing different types of activities. The patient scores each activity according to how difficult it is for them to complete it, and the max score is 30 points.. The score on the Severity Scale assesses the signs and symptoms of the dystonia. Based on the maximal excursion of the dystonic posture, the duration of the tremor, the effect of sensory tricks on alleviating the symptoms, the presence of shoulder elevation or anterior displacement, the range of motion and the time able to hold the head in a neutral position, the patient gets a scor | — |
Countries
Netherlands
Contacts
Public ContactLF García Arias
Rijksuniversiteit Groningen
Outcome results
None listed